Provider Demographics
NPI:1508052044
Name:REHAB PROFESSIONALS OF CLEVELAND, INC.
Entity Type:Organization
Organization Name:REHAB PROFESSIONALS OF CLEVELAND, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:AUBE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:440-526-8566
Mailing Address - Street 1:23887 LORAIN RD
Mailing Address - Street 2:
Mailing Address - City:NORTH OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070-2227
Mailing Address - Country:US
Mailing Address - Phone:440-777-1764
Mailing Address - Fax:
Practice Address - Street 1:23887 LORAIN RD
Practice Address - Street 2:
Practice Address - City:NORTH OLMSTED
Practice Address - State:OH
Practice Address - Zip Code:44070-2227
Practice Address - Country:US
Practice Address - Phone:440-777-1764
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH 3832225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2170985Medicaid
OH23175384702OtherOHIO BUREAU WORKERS COMP
OH23175384702OtherOHIO BUREAU WORKERS COMP